Almost two in 100 Australians have rheumatoid arthritis (RA), an insidious autoimmune disease in which the body’s immune system attacks its own tissues. Globally, nearly 8% of RA sufferers will go on to develop interstitial lung disease, a complication with no current treatment that can lead to premature death.
An anti-scar drug known as pirfenidone is showing promise as a prospective treatment for interstitial lung disease associated with rheumatoid arthritis (ILD).
RA is the most common form of autoimmune disease. The most common symptoms of the disease include swelling, pain, stiffness and warmth in the joints, along with mental and physical fatigue. It can lead to joint deterioration, disability and death.
In some cases, RA can also attack organs such as the heart and lungs. In the latter, it can lead to ILD characterized by progressive thickening and scarring of lung tissue – known as fibrosis.
Read more: How rheumatoid arthritis inflammation spreads between the joints of mice
“ILD is a relatively common complication in people with rheumatoid arthritis and can progress to premature death in up to 10% of these patients,” says Joshua Solomon, MD, director of the Interstitial Lung Disease Program at National Jewish Health and first author of the study investigating the potential use of pirfenidone in the treatment of ILD.
The study was a randomized, double-blind, placebo-controlled phase 2 trial conducted at 34 institutions. Over one year, trial participants were given either pirfenidone or a placebo and their forced vital capacity (FVC) was measured.
FVC is the maximum amount of air you can forcefully exhale from your lungs after a full inhalation, and a decrease in FVC is associated with an early mortality. Patients given pirfenidone showed a reduced rate of decline in FVC over the course of a year, suggesting that the drug – which has anti-inflammatory and anti-fibrotic properties – may improve the lifespan of people with ILD.
Pirfenidone is already used to treat idiopathic pulmonary fibrosis (scarring and thickening of lung tissue without a cause).
“With this study, we demonstrate that anti-fibrotics as a class of drugs have a reproducible effect on reducing the rate of disease progression when measured by vital capacity,” says Dr. Ivan Rosas, corresponding author of the paper and professor. of medicine and chief of the division of pulmonary, critical care and sleep medicine at Baylor College of Medicine, Houston, Texas. “This could have an impact on the overall survival of these patients.”
Recruitment of participants for the trial was halted due to the pandemic, meaning that not enough participants could be enrolled in the program for the study to be considered complete.
However, this study showed that pirfenidone shows promise that deserves further investigation in terms of its safety and tolerability in patients and in slowing the rate of progression of ILD over one year.
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